HomeMy WebLinkAbout20030196.tiff Town of
AU LT
201 First Street • P.O. Box 1098 •Ault, Colorado 80610 • (970) 834-2844 • Fax (970) 834-2199
January 6, 2003
TO: Weld County Commissioners
915 10th Street
Greeley, CO 80631 rn
RE: Intergovernmental Review
LJ
Dear Commissioners:
.o
We are applying for a loan/grant with USDA Rural Development. As part of their U,
regulation Rural Development is required, per Executive Order 12372,
"Intergovernmental Review of Federal Programs,"to have proof that applicable federal,
state, and local units of government have been notified of the proposed financial
assistance and direct development activities. Along with this notification, we solicit your
comments as they pertain to the proposed project. Your comments will be greatly
appreciated and will be considered prior to Rural Development making a final decision
on the proposal.
This process takes place of the "Single Point of Contact" for the intergovernmental
review of federal programs, which was administered by the Colorado Department of
Local Affairs. Their process was discontinued on June 1, 1995.
Town of Ault is submitting SF 424.2, "Application for Federal Assistance," for the Area.
We respectfully request that you notify us concerning this project and our request for
financial assistance if you have concerns or comments no later than March 1, 2003.
Should you have any questions, please call me at (970) 834-2844.
We thank you for your prompt attention in this matter and the submittal of any comments
you may have.
Sincerely, tiaeL
Lnr \\ p Pa yktiSt ey D. ass t
Mayor y
Town of Ault � °'¢42—VA-6.Q_) )4(2- c`'-`ee re•
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2003-0196
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CTown of
AULT
201 First Street • P.O. Box 1098 •Ault, Colorado 80610 • (970) 834-2844 • Fax (970) 834-2199
January 6, 2003
USDA/RD
655 Parfet Street
Room E100 O
Lakewood, Colorado 80215 J�
Attn: C&BP NJ,
Re: Initial Application for a Rural Utilities Service Loan or Grant
Dear Sirs/Madams:
In accordance with the application requirements for a Rural Utilities Service Loan or
Grant, enclosed are the following items:
1) One copy of a completed Standard Form 424.2 (U.S. Department of
Agriculture Application for Federal Assistance).
2) One copy of the correspondence notifying Weld County of the pending
project. Any response received will be forwarded to you upon receipt.
3) Two copies of the Engineering Feasibility Study for the pending project. If
necessary, this study will be revised to meet RUS Bulletin 1780-3
requirements, but the study should suffice for determination of project
eligibility.
4) One copy of a completed Water and Waste Eligibility Certification(RUS
Bulletin 1780-22).
5) Supporting documentation, including the 2001 audit and the 2003 budget,
necessary to make an eligibility determination.
In accordance with the guidelines for the application requirements, an environmental
assessment, in conformance with RUS Instruction 1794, will be completed under the
guidance of USDA/RD.
The Town of Ault's Internal Revenue Service Taxpayer Identification Number(TIN) is
provided in item number 6 of the U.S. Department of Agriculture Application for Federal
Assistance (Standard Form 424.4).
AUnique Little Town
USDA/RD
January 6, 2003
Page Two
In accordance with the guidelines for the application requirements, all public information
requirements will be fulfilled. These requirements include (a) a public notice of intent to
file an application with USDA and(b) a general public meeting regarding the
development of the proposed project.
In regard to the public notice of intent to file an application, said notice will be published
within 60 days of the date of this correspondence in a newspaper of general circulation of
the Town.
In regard to the public meeting, said meeting will be held not later than loan or grant
approval. At least 10 days prior to the meeting, the Town will publish a notice of the
meeting in a newspaper of general circulation of the Town, post a public notice of the
meeting at the Town Hall and notify USDA of the meeting.
The Town will provide USDA with a copy of each published notice and minutes of the
public meeting.
Thank you in advance for your assistance in processing this application. Should you
have any comments or questions, please contact me at 970-834-2844.
Respectfully submitted,
TOWN OF AULT, COLORADO
Stanley D. s
Mayor
SDC/bs/ss
Enclosures
APPLICATION FOR OMB Approval No.0348-0043
FEDERAL ASSISTANCE 2.DATE SUBMITTED Applicant Identifier
January 6, 2003
1.TYPE OF SUBMISSION: 3.DATE RECEIVED BY STATE State Application Identifier
plication Preapplication
✓ Construction 0 Construction 4.DATE RECEIVED BY FEDERAL AGENCY Federal Identifier
0 Non-Construction 0 Non-Construction
5.APPLICANT INFORMATION
Legal Name: Organizational Unit:
Town of Ault Statutory
Address(give city,county,State,and zip code): Name and telephone number of person to be contacted on matters involvin(
201 First Street this application(give area code)
Stanley D. Cass, Mayor
P.O. Box 1098, Ault, CO 80610
(970) 834-2844
6.EMPLOYER IDENTIFICATION NUMBER(EIN): 7.TYPE OF APPLICANT:(enter appropriate letter in box)
8 4 - 6N01010161314 C
A.State H.Independent School Dist.
8.TYPE OF APPLICATION: B.County I.State Controlled Institution of Higher Learning
C.MunicipalJ.Private University
2 New ❑Continuation 0 Revision
D.Township K Indian Tribe
If Revision,enter appropriate letter(s)in box(es) E.Interstate L Individual
F.Intennunidpal M.Profit Organization
A Increase Award B.Decrease Award C.Increase Duration G.Special District N.Other(Specify)
D.Decrease Duration Other(specily):
9.NAME OF FEDERAL AGENCY:
USDA Rural Development
10.CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 11.DESCRIPTIVE TITLE OF APPLICANTS PROJECT:
1 0 - 7 6 1 0 Wastewater Treatment Facility Improvements
TITLE: Water&Waste Disposal System for rural communities
12.AREAS AFFECTED BY PROJECT(Cities,Counties,States,etc.):
Town of Ault, Weld County, Colorado
13.PROPOSED PROJECT 14.CONGRESSIONAL DISTRICTS OF:
Start Date Ending Date a.Applicant b.Project
10/1/03 4/1/04 Fourth Fourth
15.ESTIMATED FUNDING: 16.IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE
ORDER 12372 PROCESS?
a Federal •(USDA) $ 550,000 m a YES. THIS PREAPPUCATION/APPLICATION WAS MADE
b.Applicant $ 00 AVAILABLE TO THE STATE EXECUTIVE ORDER 12372
150,000 PROCESS FOR REVIEW ON:
c.State $ m
0 DATE 02/27/02
d. Local (D0LA) $ m
300,000 b.No. O PROGRAM IS NOT COVERED BY E.O.12372
e'Other $ 00 O OR PROGRAM HAS NOT BEEN SELECTED BY STATE
0 FOR REVIEW
f.Program Income $ °0
0 17.IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
g.TOTAL $ o^
1,000,000 0 Yes If''Yes,"attach an explanation. ®No
18.TO THE BEST OF MY KNOWLEDGE AND BELIEF,ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT,THE
DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE
ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
a.Type Name of Authorized Representative b.Title c.Telephone Number
Stanley D. Cass MayoJJ (970) 834-2844
d.Signature of Authorized Repress ry e.Date g
/�/ 3
Previous Edition Usable Standard Form 424(Rev.7-97)
Authorized for Local Reproduction Prescribed by OMB Circular A-102
INSTRUCTIONS FOR THE SF-424
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden,to the Office of Management and Budget, Paperwork Reduction Project(0348-0043),Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
This is a standard form used by applicants as a required facesheet for preapplications and applications submitted for Federal assistance. It
will be used by Federal agencies to obtain applicant certification that States which have established a review and comment procedure in
response to Executive Order 12372 and have selected the program to be included in their process, have been given an opportunity to review
the applicant's submission.
Rem: Entry: Item: Entry:
1. Self-explanatory. 12. List only the largest political entities affected (e.g.,State,
counties,cities).
2. Date application submitted to Federal agency(or State if
applicable)and applicant's control number(if applicable). 13. Self-explanatory.
3. State use only(if applicable). 14. List the applicant's Congressional District and any
District(s)affected by the program or project.
4. If this application is to continue or revise an existing award,
enter present Federal identifier number.If for a new project, 15. Amount requested or to be contributed during the first
leave blank. fundin
g/budget period by each contributor.Value of in-
kind contributions should be included on appropriate
5. Legal name of applicant,name of primary organizational unit lines as applicable. If the action will result in a dollar
which will undertake the assistance activity,complete address of change to an existing award,indicate onty the amount
the applicant,and name and telephone number of the person to of the change.For decreacos, enclose the amounts in
contact on matters related to this application. parentheses. If both basic and supplemental amounts
are included,show breakdown on an attached sheet.
6. Enter Employer Identification Number(EIN)as assigned by the For multiple program fundng, use totals and show
Internal Revenue Service. breakdown using same categories as item 15.
7. Enter the appropriate letter in the space provided. 16. Applicants should contact the State Single Point of
Contact(SPOC)for Federal Executive Order 12372 to
8. Check appropriate box and enter appropriate letters)in the determine whether the application is subject to the
space(s)provided: State intergovernmental review process.
--"New° means a new assistance award. 17. This question applies to the applicant organization, not
the person who signs as the authorized representative.
—"Continuation"means an extension for an additional Categories of debt include delinquent audit
funding/budget period for a project with a projected disallowances,loans and taxes.
completion date.
18. To be signed by the authorized representative of the
--"Revision"means any change in the Federal applicant.A copy of the governing body's
Government's financial obligation or contingent authorization for you to sign this application as official
liability from an existing obligation. representative must be on file in the applicant's office.
(Certain Federal agencies may require that this
9. Name of Federal agency from which assistance is being authorization be submitted as part of the application.)
requested with this application.
10. Use the Catalog of Federal Domestic Assistance number and
title of the program under which assistance is requested.
11. Enter a brief descriptive title of the project. if more than one
program is involved,you should append an explanation on a
separate sheet.If appropriate(e.g.,construction or real
property projects),attach a map showing project location.For
preapplications,use a separate sheet to provide a summary SF-424(Rev.7-97)Back
description of this project.
OMB Approval No.0348-0041
BUDGET INFORMATION - Construction Programs
NOTE. Certain Federal assistance programs require additional computations to arrive at the Federal share of project costs eligible for participation. If such is the case,you will be notified.
COST CLASSIFICATION a.Total Cost b. Costs Not Allowable c.Total Allowable Costs
for Participation (Columns a-b)
1. Administrative and legal expenses $ 5,000 .00 $ 0.00 $ 5,000.00
2. Land, structures, rights-of-way,appraisals,etc. $ 0 .00 $ 0.00 $ 0.00
3. Relocation expenses and payments $ 0.00 $ .00 $ 0.00
4. Architectural and engineering fees $ 50,000 .00 $ .00 $ 50,000.00
i 5. Other architectural and engineering fees $ 15,000 .00 $ .00 $ 15,000.00
6. Project inspection fees $ 55,000 .00 $ .00 $ 55,000.00
7. Site work $ 225,000 .00 $ .00 $ 225,000.00
8. Demolition and removal $ 45,000 .00 $ .00 $ 45,000.00
9. Construction $ 325,000 .00 $ .00 $ 325,000.00
10. Equipment $ 148,000 .00 $ .00 $ 148,000.00
11. Miscellaneous $ 2,000 .00 $ .00 $ 2,000 .00
12. SUBTOTAL (sum of lines 1-11) $ 870,000 .00 $ 0.00 $ 870,000.00
13. Contingencies $ 130,000 .00 $ .00 $ 130,000.00
14. SUBTOTAL $ 1,000,000 .00 $ 0.00 $ 1,000,000.00
15. Project(program) income $ .00 $ .00 $ 0.00
16. TOTAL PROJECT COSTS (subtract#15 from#14) $ 1,000,000.00 $ 0.00 $ 1,000,000.00
FEDERAL FUNDING
17. Federal assistance requested,calculate as follows:
(Consult Federal agency for Federal percentage share.) 100.00
Enter eligible costs from line 16c Multiply X % $ 1,000,000.00
Enter the resulting Federal share.
Previous Edition Usable Authorized for Local Reproduction Standard Form 424C(Rev.7-97)
Prescribed by OMB Circular A-102
RUS Bulletin 1780-22
WATER AND WASTE
ELIGIBILITY CERTIFICATION
Certification for commercial credit and outstanding judgments
The undersigned certifies,to the best of their knowledge and belief,that:
1. The organization is unable to finance the proposed project from its own resources or through commercial
credit at reasonable rates and terms.
2. No outstanding judgment has been obtained and recorded by the United States of America in a Federal
Court(other than in the United States Tax Court).
Town of Ault
Name of Organization
Stanley D.Cass
Name of Authorized Official
4—ict,4k January 6,2003
Signature Date
OMB Approval No.0348-0042
ASSURANCES-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed,and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden,to the Office of Management and Budget,Paperwork Reduction Project(0348-0042),Washington,DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional
assurances.If such is the case,you will be notified.
As the duly authorized representative of the applicant,I certify that the applicant
1. Has the legal authority to apply for Federal assistance, 8. Will comply with the Intergovernmental Personnel Act
and the institutional, managerial and financial capability of 1970(42 U.S.C. §§4728-4763) relating to prescribed
(including funds sufficient to pay the non-Federal share standards for merit systems for programs funded
of project costs) to ensure proper planning, under one of the 19 statutes or regulations specified in
management and completion of the project described in Appendix A of OPM's Standards for a Merit System of
this application. Personnel Administration(5 C.F.R.900,Subpart F).
2. Will give the awarding agency,the Comptroller General 9. Will comply with the Lead-Based Paint Poisoning
of the United States and, if appropriate, the State, Prevention Act (42 U.S.C. §§4801 et seq.) which
through any authorized representative, access to and prohibits the use of lead-based paint in construction or
the right to examine all records, books, papers, or rehabilitation of residence structures.
documents related to the assistance; and will establish
a proper accounting system in accordance with 10. Will comply with all Federal statutes relating to non-
generally accepted accounting standards or agency discrimination. These include but are not limited to: (a)
directives. Title VI of the Civil Rights Act of 1964 (P.L 88-352)
which prohibits discrimination on the basis of race,
3. Will not dispose of, modify the use of, or change the color or national origin; (b) Title IX of the Education
terms of the real property title, or other interest in the Amendments of 1972, as amended (20 U.S.C. §§1681
site and facilities without permission and instructions 1683, and 1685-1686), which prohibits discrimination
from the awarding agency. Will record the Federal on the basis of sex; (c) Section 504 of the
interest in the title of real property in accordance with Rehabilitation Act of 1973, as amended (29 U.S.C.
awarding agency directives and will include a covenant §794), which prohibits discrimination on the basis of
in the title of real property aquired in whole or in part handicaps; (d) the Age Discrimination Act of 1975, as
with Federal assistance funds to assure non- amended (42 U.S.C. §§6101-6107), which prohibits
discrimination during the useful life of the project. discrimination on the basis of age; (e) the Drug Abuse
Office and Treatment Act of 1972 (P.L 92-255), as
4. Will comply with the requirements of the assistance amended, relating to nondiscrimination on the basis of
awarding agency with regard to the drafting, review and drug abuse; (f) the Comprehensive Alcohol Abuse and
approval of construction plans and specifications. Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L 91-616), as amended, relating to
5. Will provide and maintain competent and adequate nondiscrimination on the basis of alcohol abuse or
engineering supervision at the construction site to alcoholism; (g) §§523 and 527 of the Public Health
ensure that the complete work conforms with the Service Act of 1912 (42 U.S.C. H290 dd-3 and 290 ee
approved plans and specifications and will furnish 3), as amended, relating to confidentiality of alcohol
progress reports and such other information as may be and drug abuse patient records; (h) Title VIII of the
required by the assistance awarding agency or State. Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.),as
amended, relating to nondiscrimination in the sale,
6. Will initiate and complete the work within the applicable rental or financing of housing; (i) any other
time frame after receipt of approval of the awarding nondiscrimination provisions in the specific statute(s)
agency. under which application for Federal assistance is being
made; and, (j) the requirements of any other
7. Will establish safeguards to prohibit employees from nondiscrimination statute(s) which may apply to the
using their positions for a purpose that constitutes or application.
presents the appearance of personal or organizational
conflict of interest, or personal gain.
Standard Form 424D(Rev.7-97)
Previous Edition Usable Authorized for Local Reproduction Prescribed by OMB Circular A-102
11. Will comply, or has already complied, with the National Environmental Policy Act of 1969 (P.L 91-
requirements of Titles II and 111 of the Uniform Relocation 190) and Executive Order (EO) 11514; (b) notification
Assistance and Real Property Acquisition Policies Act of of violating facilities pursuant to EO 11738; (c)
1970 (P.L 91-646) which provide for fair and equitable protection of wetlands pursuant to EO 11990; (d)
treatment of persons displaced or whose property is evaluation of flood hazards in floodplains in accordance
acquired as a result of Federal and federally-assisted with EO 11988; (e) assurance of project consistency
programs. These requirements apply to all interests in real with the approved State management program
property acquired for project purposes regardless of developed under the Coastal Zone Management Act of
Federal participation in purchases. 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of
Federal actions to State (Clean Air) Implementation
12. Will comply with the provisions of the Hatch Act (5 U.S.C. Plans under Section 176(c) of the Clean Air Act of
§§1501-1508 and 7324-7328) which limit the political 1955, as amended (42 U.S.C. §§7401 et seq.); (g)
activities of employees whose principal employment protection of underground sources of drinking water
activities are funded in whole or in part with Federal funds. under the Safe Drinking Water Act of 1974, as
amended (P.L 93-523); and, (h) protection of
13. Will comply, as applicable,with the provisions of the Davis- endangered species under the Endangered Species Act
Bacon Act(40 U.S.C. §§276a to 276a-7),the Copeland Act of 1973,as amended(P.L 93-205).
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract
Work Hours and Safety Standards Act (40 U.S.C. H327- 16. Will comply with the Wild and Scenic Rivers Act of
333) regarding labor standards for federally-assisted 1968 (16 U.S.C. H1271 et seq.) related to protecting
construction subagreements. components or potential components of the national
wild and scenic rivers system.
14. Will comply with flood insurance purchase requirenrerdb of
Section 102(a) of the Flood Disaster Protection Act of 1973 17. Will assist the awarding agency in assuring compliance
(P.L 93-234) which requires recipients in a special flood with Section 106 of the National Historic Preservation
hazard area to participate in the program and to purchase Act of 1966, as amended (16 U.S.C. §470), EO 11593
flood insurance if the total cost of insurable construction (identification and protection of historic properties),and
and acquisition is$10,000 or more. the Archaeological and Historic Preservation Act of
1974(16 U.S.C.§§469a-1 et seq.).
15. Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of 18. Will cause to be performed the required financial and
environmental quality control measures under the compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMB Circular No.A-133,
"Audits of States, Local Governments, and Non-Profit
Organizations."
19. Will comply with all applicable requirements of all other
Federal laws,executive orders, regulations,and policies
governing this program.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE
'24fr __� Mayor
APPLICANT ORGANIZATION DATE SUBMITTED
Town of Ault
January 6, 2003
SF-24D(Rev.747)Back
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